If you were referred, please provide the name of the person who referred you so you AND your friend can each receive a $10.00 credit to your account which can be used for any services offered within Mercy Fitness Center.

Emergency Contact Name*

FirstLast

Contact Number*

Emergency Contact Email*

* The contact name & number above is the number we will utilize for all emergency closings, make ups and any other correspondence needed from the Aquatic’s Department.

Has this person had lessons before?

Yes

No

If yes:

Please describe the experience (1-on-1; group; length of time; etc.)

I am interested in learning more about:*

Aqua Babies

Aqua Pilates

Aqua Personal Training

Kids' Learn-to-Swim: Level 1

Kids' Learn-to-Swim: Level 2

Private/Duo Adult Lessons

Private/Duo Child Lessons (3+)

Swim Skill Set Analysis

TRI-Swim

Other

(1) Swimmer's Name*

Age*

Birthday*

Date Format: MM slash DD slash YYYY

Adult

Child

(2) Swimmer's Name

Age

Birthday

Date Format: MM slash DD slash YYYY

Adult

Child

Duo Lessons

Yes

No

Do you require duo lessons (only choose 'yes' If registering 2 individuals at the same level)

Do any of the following apply?

This student a visual learner

This student faces learning challenges

This student is a hands-on learner

By knowing these answers, we can best match the student with the most appropriate swim instructor.

Special Needs*

If none, mark n/a

Medical Conditions/Allergies*

If none, mark n/a

When and what times are you available to train/take lessons? (Select all that apply)

Once you've selected the day(s), please select the time(s) below.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Monday

Early morning (6 a.m. - 8 a.m.)

Morning (8 a.m. - noon)

Afternoon (1 p.m. - 5 p.m.)

Evening (5 p.m. - 8 p.m.)

Tuesday

Early morning (6 a.m. - 8 a.m.)

Morning (8 a.m. - noon)

Afternoon (1 p.m. - 5 p.m.)

Evening (5 p.m. - 8 p.m.)

Wednesday

Early morning (6 a.m. - 8 a.m.)

Morning (8 a.m. - noon)

Afternoon (1 p.m. - 5 p.m.)

Evening (5 p.m. - 8 p.m.)

Thursday

Early morning (6 a.m. - 8 a.m.)

Morning (8 a.m. - noon)

Afternoon (1 p.m. - 5 p.m.)

Evening (5 p.m. - 8 p.m.)

Friday

Early morning (6 a.m. - 8 a.m.)

Morning (8 a.m. - noon)

Afternoon (1 p.m. - 5 p.m.)

Evening (5 p.m. - 8 p.m.)

Saturday

Early morning (6 a.m. - 8 a.m.)

Morning (8 a.m. - noon)

Afternoon (1 p.m. - 5 p.m.)

Evening (5 p.m. - 8 p.m.)

Sunday

Early morning (6 a.m. - 8 a.m.)

Morning (8 a.m. - noon)

Afternoon (1 p.m. - 5 p.m.)

Evening (5 p.m. - 8 p.m.)

Signature Line*

By entering your name here, you agree you have read, understand and adhere to all policies herein (see Mercy Fitness Center Aquatics Program Policies below). In addition, you agree the information you provided Is accurate and complete. You hereby release, waive, and relinquish any and all actions for personal injury arising as a result of participating in such program-mentions swimming program.

Date*

Date Format: MM slash DD slash YYYY

MERCY FITNESS CENTER AQUATICS PROGRAM POLICIES

Goal:

The goal of Mercy Fitness Center’s aquatics private swim lesson service is to produce happy, skilled, safer swimmers, while building self-esteem and creating a love for the water. We offer nationally recognized curriculum and teaching methodologies for swimmers ages 3 and above. Along with children’s solo lessons (one-on-one) and duo’s (two students to one instructor), we also offer Adult Private Swim Lessons. These lessons are appropriate for any level of adult swimmers.

Whether you are an adult who wants to be more confident and safe around water or are an active swimmer looking for stroke refinement, we can help! We are committed to professional swim lessons with a nurturing, fun environment and an exceptional positive fitness experience. Please adhere to the following list of our guidelines and assist in your child’s success:

Swim Lesson Requests: All private swim lesson requests can be submitted via the online submission form OR the in-person printed form. All requests will have return contact within three (3) business days to confirm the request was received. A qualified and available Mercy Fitness Center Swim Instructor will work with you to finalize a start day for your lessons and review all policies and procedures. We offer different package sizes and lesson options such as private lessons, duo lessons, and swim packages (3-lesson intro pack, 4-pack, and 8-pack). Payment is due prior to first lesson starting. NOTE: We offer referral discounts!! Please contact the Aquatic Department for more information.

Scheduling: When requesting private lessons, please be specific with the days/times you are available to attend lessons. Please choose days/times you can attend on a consistent basis. The goal is that each client is provided at least three (3) swim lessons each month, unless prearranged with your instructor. Please know that any lesson cancelled, by the client, with less than 24 hours’ notice can result in a charge for that day’s lesson. Also, any lesson cancelled with less than 24 hours’ notice, from the instructor, will equal ONE additional lesson added to your account.

Requesting/Scheduling “Duo” Lessons: We are excited to offer “duo” lessons! This is for any TWO participants with equal (or very close) swimming abilities. Applicable to both children and adults. Duo lessons are scheduled with your instructor and purchased separately by each participant. Please know that both participants will be charged for a lesson each week, unless pre-approved by your instructors. We don't charge them automatically each week. BUT one person CANNOT attend a lesson without the other. If one person attends the other one will be charged as well.
NOTE: We offer referral discounts! Please contact the Aquatic Department for more information.

To Cancel/Reschedule: Mercy Fitness Center has a minimum 24-hour cancellation policy. All lesson changes are to be communicated directly with the instructor. It is the client’s responsibility to contact the instructor to change or cancel the lesson for that week. Equally, the instructor will communicate directly with the client for any scheduling needs.

It is expected that the client will make all efforts to have lessons on the pre-arranged day/time. Should the Mercy Fitness Center pool be closed for any reason during the scheduled time of the lesson, the client will not be charged for the lesson. Should the client fail to attend the set day/time for the lesson without at least 24 hours’ notice, the client will be automatically charged for the lesson.

All training services purchases are non-refundable and non-transferrable, and will expire one (1) year from purchase date. Please contact the aquatics department at (405) 757-3300 or email at aquatics@mercyfitness.net

Locker Room/Other Policy: Children under 16 years old are not permitted in the adult locker room at any time. They are required to use the family locker room only and must be accompanied by an adult. Children over 16 years old must be accompanied by an adult in the adult locker room. Any child who is NOT receiving private swim lessons must be placed in the Kids' Zone at a discounted rate.

Photos/Video: Photos of your (or your child’s) swim lessons are permitted. However, out of courtesy for other members, posting any image (photo, video, etc.) of anyone other than yourself/your child on any social media platform is strictly prohibited. It is also prohibited to post any image of your swim instructor without his or her permission. Should you be interested in providing testimonials, please contact Mercy Fitness Center management.

Required Swim Gear: For each swim lesson, the child must have a swim suit and towel.

Code of Conduct: All persons on Mercy Fitness Center premises are required to conduct themselves appropriately. This includes, but is not limited to: swim students in the pool, children outside the pool, and parents/guardians, whether in the pool, in the pool area, or in the locker rooms. Parents/guardians are required to monitor their children and support this policy the entire time they are on the premises.

Health: Please tell your coach if your child has any medical problems, disabilities, or fears. Do not bring a sick child to class. This includes yellow or green nose secretions, pink eye, fever, etc. If your child displays any of these or other symptoms of illness, it may be necessary to remove the child from the lesson. Please keep your child home for at least 24 hours after all symptoms have passed.

Safety: Swimmers are required to follow the facility’s policies and safety rules. The parent is primarily responsible for the safety of all minor children accompanying him/her to the facility. A waiver of liability statement must be signed by the parent or guardian at the reception desk, before the start of the swim lesson. Please arrive early to your first lesson to allow time for this requirement. Parents must remain on the pool deck for the duration of their child’s/children’s swimming lesson.

In consideration of permitting my child/children to participate in swimming activities, I hereby release, waive, and relinquish any and all actions for personal injury arising as a result of participating in such program.

By clicking submit, I am also stating that I have read and accept the terms and conditions as they are stated in the waivers below.

Adult Swim Waiver

Child Swim Waiver

By submitting this form, I consent to receive communications from Mercy Fitness Center.